Optimizing Ultrasound-Guided Placement of Cardiac Implantable Electronic Devices: Current Uses and Challenges

Abstract

Cardiac implantable electronic devices are an effective treatment for heart rhythm disorders. Currently, x-ray imaging—especially fluoroscopy—is the standard method used to guide the implantation process and assess its effectiveness. However, due to risks associated with radiation exposure, ultrasound is being explored as an alternative to traditional imaging modality. The growing interest in adopting ultrasound as the primary imaging modality during implantation emphasizes the need for practitioners, particularly cardiac electrophysiologists, to be aware of its advantages as well as its limitations. This article discusses the existing and possible future uses of ultrasound in CIED implantation, explores new US-based technologies that could support its usage, and discusses the potential drawbacks associated with it. Additionally, it offers recommendations for enhancing the proficiency of ultrasound-guided implantation and mitigating its limitations.

Summary

• Question: What is the scope of use of ultrasound in cardiac device implantation?
• Findings: Studies show that ultrasound is safe for vascular access to reduce complications; aid in lead implantation on the ventricular septum, preventing cardiac perforation; and adjust slack to prevent lead-related tricuspid regurgitation.
• Clinical Relevance Statement: The clinical relevance of these findings is to help physicians utilize ultrasound during routine cardiac device implantation to enhance clinical outcomes and minimize complications, especially in the era of left bundle branch area pacing.